Acropustulosis of Infancy

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Infantile acropustulosis is a recurrent, self-limited, pruritic, vesicopustular eruption of the palms and the soles occurring in young children during the first 2-3 years of life. First described in 1979, infantile acropustulosis is probably much more common than the scarcity of reports would imply. ^{[1, 2]}

The pathophysiology of infantile acropustulosis is unknown. Many cases of infantile acropustulosis are preceded by well-documented or suspected scabies infestation, and a scabies id reaction has been suggested. ^{[3, 4, 5]} The condition is fairly common among children adopted from foreign countries, a setting where scabies might be suspected. ^[6] More often, cases of infantile acropustulosis occur despite scabies having been thoroughly ruled out.

Bacterial and viral culture results are consistently negative, and negative immunofluorescence results suggest that infantile acropustulosis is not an antibody-mediated autoimmune process.

An association with atopic dermatitis has been noted. ^[6]

The most recently recognized cause of infantile pustulosis is a deficiency of interleukin 1 receptor antagonist (DIRA), which is a recessive syndrome caused by a loss of function mutation resulting in unopposed action of interleukin 1 and life-threatening systemic inflammation. ^[7] This should be distinguished from localized infantile acropustulosis.

The exact incidence of infantile acropustulosis is unknown. One study from Israel reported 25 cases of infantile acropustulosis in a 9-year period, suggesting that this is not as uncommon as once thought. ^[8]

Early reports suggested a predominance of African Americans for infantile acropustulosis. Now, acropustulosis of infancy is believed to affect all races equally.

Early reports suggested a male predominance for infantile acropustulosis. Larger series have since shown an equal distribution between males and females. ^{[5, 8]}

Although children as old as 9 years have been reported to have infantile acropustulosis, acropustulosis of infancy typically begins between the first 2-12 months of life. ^[8] Resolution by age 3 years is the norm.

Prognosis is for infantile acropustulosis excellent. Generally, the bouts of pruritic vesicopustules decrease in severity with successive outbreaks and resolve by age 2-3 years.

Kahn G, Rywlin AM. Acropustulosis of infancy. Arch Dermatol. 1979 Jul. 115(7):831-3. [Medline].

Zuniga R, Nguyen T. Skin conditions: common skin rashes in infants. FP Essent. 2013 Apr. 407:31-41. [Medline].

Humeau S, Bureau B, Litoux P, Stalder JF. Infantile acropustulosis in six immigrant children. Pediatr Dermatol. 1995 Sep. 12(3):211-4. [Medline].

Prendiville JS. Infantile acropustulosis–how often is it a sequela of scabies?. Pediatr Dermatol. 1995 Sep. 12(3):275-6. [Medline].

Mancini AJ, Frieden IJ, Paller AS. Infantile acropustulosis revisited: history of scabies and response totopical corticosteroids. Pediatr Dermatol. 1998 Sep-Oct. 15(5):337-41. [Medline].

Good LM, Good TJ, High WA. Infantile acropustulosis in internationally adopted children. J Am Acad Dermatol. 2011 Oct. 65(4):763-71. [Medline].

Minkis K, Aksentijevich I, Goldbach-Mansky R, et al. Interleukin 1 receptor antagonist deficiency presenting as infantile pustulosis mimicking infantile pustular psoriasis. Arch Dermatol. 2012 Jun. 148(6):747-52. [Medline]. [Full Text].

Dromy R, Raz A, Metzker A. Infantile acropustulosis. Pediatr Dermatol. 1991 Dec. 8(4):284-7. [Medline].

Ghosh S. Neonatal pustular dermatosis: an overview. Indian J Dermatol. 2015 Mar-Apr. 60 (2):211. [Medline]. [Full Text].

Infantile acropustulosis. Larralde M, Boldrini MP, Luna PC, Abad ME, Marín CC. Dermatología Argentina. 2013. 16(2010):268-71.

Truong AL, Esterly NB. Atypical acropustulosis in infancy. Int J Dermatol. 1997 Sep. 36(9):688-91. [Medline].

DeLeon SD, Melson SC, Yates AB. Crawling Toward a Diagnosis: Vesicles and Thrombocytopenia in a Neonate. Hosp Pediatr. 2015 Oct. 5 (10):555-7. [Medline]. [Full Text].

Truong AL, Esterly NB. Atypical acropustulosis in infancy. Int J Dermatol. 1997 Sep. 36(9):688-91. [Medline].

Kimura M, Higuchi T, Yoshida M. Infantile acropustulosis treated successfully with topical maxacalcitol. Acta Derm Venereol. 2011 May. 91(3):363-4. [Medline].

Vicente J, Espana A, Idoate M, et al. Are eosinophilic pustular folliculitis of infancy and infantile acropustulosis the same entity?. Br J Dermatol. 1996 Nov. 135(5):807-9. [Medline].

Cassondra M Ellison, MD Resident Physician, Department of Dermatology, The Commonwealth Medical College

Cassondra M Ellison, MD is a member of the following medical societies: American Medical Student Association/Foundation

Disclosure: Nothing to disclose.

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Michael J Wells, MD, FAAD Dermatologic/Mohs Surgeon, The Surgery Center at Plano Dermatology

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Van Perry, MD Assistant Professor, Department of Medicine, Division of Dermatology, University of Texas School of Medicine at San Antonio

Van Perry, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Daniel Mark Siegel, MD, MS Clinical Professor of Dermatology, Department of Dermatology, State University of New York Downstate Medical Center

Daniel Mark Siegel, MD, MS is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Association for Physician Leadership, American Society for Dermatologic Surgery, American Society for MOHS Surgery, International Society for Dermatologic Surgery

Disclosure: Nothing to disclose.

Howard Pride, MD Associate Physician, Departments of Pediatrics and Dermatology, Geisinger Medical Center

Howard Pride is a member of the following medical societies: American Academy of Dermatology and Society for Pediatric Dermatology

Disclosure: Nothing to disclose.

Acropustulosis of Infancy

Research & References of Acropustulosis of Infancy|A&C Accounting And Tax Services
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